Provider Demographics
NPI:1790297273
Name:ELZUGHBI, JAD (AAC)
Entity Type:Individual
Prefix:
First Name:JAD
Middle Name:
Last Name:ELZUGHBI
Suffix:
Gender:M
Credentials:AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11847 SE 319TH PL
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-3602
Mailing Address - Country:US
Mailing Address - Phone:612-718-5326
Mailing Address - Fax:206-323-2184
Practice Address - Street 1:1216 PINE ST STE 300
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1959
Practice Address - Country:US
Practice Address - Phone:206-323-1768
Practice Address - Fax:206-323-2184
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60626414101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor